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Haemodynamic characteristics of COVID-19 patients with acute respiratory distress syndrome requiring mechanical ventilation. An invasive assessment using right heart catheterization.

Authors
  • Caravita, Sergio1, 2
  • Baratto, Claudia1, 3
  • Di Marco, Fabiano4
  • Calabrese, Alice5
  • Balestrieri, Giulio5
  • Russo, Filippo6
  • Faini, Andrea1
  • Soranna, Davide1
  • Perego, Giovanni Battista1
  • Badano, Luigi P1, 3
  • Grazioli, Lorenzo6
  • Lorini, Ferdinando Luca6
  • Parati, Gianfranco1, 3
  • Senni, Michele5
  • 1 Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milan, Italy. , (Italy)
  • 2 Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy. , (Italy)
  • 3 Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. , (Italy)
  • 4 Department of Health Science, University of Milan, Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy. , (Italy)
  • 5 Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy. , (Italy)
  • 6 Intensive Care Department, ASST Papa Giovanni XXIII, Bergamo, Italy. , (Italy)
Type
Published Article
Journal
European Journal of Heart Failure
Publisher
Wiley (John Wiley & Sons)
Publication Date
Nov 16, 2020
Identifiers
DOI: 10.1002/ejhf.2058
PMID: 33200458
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Interstitial pneumonia due to coronavirus disease 2019 (COVID-19) is often complicated by severe respiratory failure. In addition to reduced lung compliance and ventilation/perfusion mismatch, a blunted hypoxic pulmonary vasoconstriction has been hypothesized, that could explain part of the peculiar pathophysiology of the COVID-19 cardiorespiratory syndrome. However, no invasive haemodynamic characterization of COVID-19 patients has been reported so far. Twenty-one mechanically-ventilated COVID-19 patients underwent right heart catheterization. Their data were compared both with those obtained from non-mechanically ventilated paired control subjects matched for age, sex and body mass index, and with pooled data of 1937 patients with 'typical' acute respiratory distress syndrome (ARDS) from a systematic literature review. Cardiac index was higher in COVID-19 patients than in controls [3.8 (2.7-4.5) vs. 2.4 (2.1-2.8) L/min/m2 , P < 0.001], but slightly lower than in ARDS patients (P = 0.024). Intrapulmonary shunt and lung compliance were inversely related in COVID-19 patients (r = -0.57, P = 0.011) and did not differ from ARDS patients. Despite this, pulmonary vascular resistance of COVID-19 patients was normal, similar to that of control subjects [1.6 (1.1-2.5) vs. 1.6 (0.9-2.0) WU, P = 0.343], and lower than reported in ARDS patients (P < 0.01). Pulmonary hypertension was present in 76% of COVID-19 patients and in 19% of control subjects (P < 0.001), and it was always post-capillary. Pulmonary artery wedge pressure was higher in COVID-19 than in ARDS patients, and inversely related to lung compliance (r = -0.46, P = 0.038). The haemodynamic profile of COVID-19 patients needing mechanical ventilation is characterized by combined cardiopulmonary alterations. Low pulmonary vascular resistance, coherent with a blunted hypoxic vasoconstriction, is associated with high cardiac output and post-capillary pulmonary hypertension, that could eventually contribute to lung stiffness and promote a vicious circle between the lung and the heart. © 2020 European Society of Cardiology.

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